Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4017 — Receipt of Evidence-Based Alcohol-Related Care among VA Patients With Hepatitis C And Unhealthy Alcohol Use

Lead/Presenter: Mandy Owens, COIN - Seattle/Denver
All Authors: Owens MD (VA Puget Sound) Ioannou G (VA Puget Sound) Tsui J (University of Washington) Edelman EJ (Yale University School of Medicine) Greene PA (VA Puget Sound) Williams EC (VA Puget Sound)

Objectives:
The VA leads the nation in provision of care for patients with hepatitis C virus (HCV). Alcohol use negatively impacts HCV progression and treatment, making it particularly important for VA patients with HCV and unhealthy alcohol use to receive evidence-based alcohol-related care; however, it is unknown the extent to which these patients do. We used national VA data to examine receipt of recommended evidence-based alcohol-related treatments, including brief interventions among HCV-infected patients with unhealthy alcohol use, and specialty treatment or medications among those with an alcohol use disorder (AUD).

Methods:
VA data from CDW identified patients with ICD-9 codes for HCV, among all positive screens for unhealthy alcohol use (AUDIT-C?5) from 10/01/09-5/30/13. Unadjusted and adjusted Poisson regression models with robust standard errors estimated the prevalences and 95% confidence intervals (CI) of receipt of brief intervention within 14 days of a positive alcohol screen among all records. Among those who additionally had an AUD diagnosis, models examined receipt of specialty addictions treatment and AUD medications (naltrexone, disulfiram, acamprosate, or topiramate) in the year following positive screening. Adjusted models included demographic and clinical characteristics.

Results:
Among 31,841 eligible patients with HCV and unhealthy alcohol use, the unadjusted and adjusted prevalences of brief intervention were 69.2% (CI, 68.7-69.6) and 71.9% (CI, 71.4-72.4), respectively. Among the 20,320 (64%) with an AUD diagnosis, the unadjusted and adjusted prevalences of receiving specialty addictions treatment were 40.0%, (CI, 39.3-40.6) and 26.7% (CI, 26.3-27.1), respectively, and of receiving AUD medications were 8.1% (CI, 7.7-8.4) and 6.4% (CI, 6.1-6.6), respectively.

Implications:
Findings highlight gaps in receipt of recommended alcohol-related care for patients with HCV and unhealthy alcohol use. While most received brief interventions, approximately one-third still did not. Moreover, among those with an AUD (the majority of all patients), two-thirds did not receive specialty addictions treatment and > 90% did not receive AUD medications.

Impacts:
Current VA guidelines recommend targeting unhealthy alcohol use for patients presenting for HCV treatment. Because alcohol use may undermine the VA's efforts to treat HCV, future research should target increasing access to alcohol-related treatments for patients with HCV.